Provider Demographics
NPI:1538143888
Name:BAUMAN, KIMBERLEY L (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLEY
Middle Name:L
Last Name:BAUMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:BOX 801205
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22908-1205
Mailing Address - Country:US
Mailing Address - Phone:434-243-4500
Mailing Address - Fax:434-293-8570
Practice Address - Street 1:2955 IVY ROAD
Practice Address - Street 2:SUITE 205
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-1205
Practice Address - Country:US
Practice Address - Phone:434-243-4500
Practice Address - Fax:434-293-8570
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101049102207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5128211OtherAETNA
VA110223492OtherMEDICARE RAILROAD
VA893814OtherMAMSI
VA141034OtherANTHEM
VA005808332Medicaid
VA142730OtherSOUTHERN HEALTH
VA014930OtherCIGNA
VA005808332Medicaid
VA5128211OtherAETNA